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The athlete with shoulder pain: how to move from a diagnostic dilemma, and a therapeutic drama, to an exciting challenge? ~ Babette Pluim, MD, PhD, MPH

Shoulder injuries in overhead athletes can be very challenging for even the most experienced clinicians. I have worked in tennis for the last 22 years and I know that no two shoulder injuries are quite the same and no shoulder injury is ever entirely easy! My initial gut reaction would be “oh, oh, here we go again” because tennis players, like all elite athletes, want to continue playing and a quick, shoulder fix, seldom works in an overhead athlete.

If you are very lucky, a few days of rest might be sufficient, but more often than not, the injury will not resolve without weeks of careful rehab. The athlete will become steadily more desperate, and your confidence will start to waver. Thankfully, the days of reckless NSAIDs use and steroid injections are long past and we now have a better understanding of the underlying pathology (SLAP, GIRD and scapular dyskinesia) and how to manage these entities in an evidence-based way.

Photo by emmett.hume. Used with permission. All rights reserved. Source: flickr

Photo by emmett.hume. Used with permission. All rights reserved. Source: flickr

But where do you start, what do you do, when do you do it and how do you manage your athlete’s expectations? The playing field has changed enormous in recent years and the general medical textbooks cannot possibly keep up with the latest advances in shoulder injury management.

This is where the book (so much more than just a book!) comes in –Clinical Sports Medicine. I was very fortunate to have been invited to co-author Chapter 21 on Shoulder Pain with Dr. Ben Kibler and Prof. George Murrell and researching the chapter with these experts has been a revelation. I know that I am a better clinician as a result and I’m sure that the book can help you to better manage your athletes and resolve their injuries.

The chapter starts off with six entities, each of which can be responsible for shoulder discomfort – the rotator cuff, instability, labral injury, stiffness, AC joint pathology and referred pain. Each segment takes you through the classical clinical evaluation process – history, examination, and investigations (x-ray, ultrasound, MRI, arthrography and diagnostic arthroscopy) –and not only are all the shoulder tests explained in the text, you can actually watch a video of the tests being conducted by Dr Mark Hutchinson (via the dedicated CSM website, available to you when you buy the book).

For those of you who are not familiar with Mark’s work, he is the creator of the famous YouTube knee examination series which has achieved over 3.6 million downloads. This is followed by sections on the rare shoulder injuries, the principles of shoulder rehabilitation and a final section on “putting it all together”.

So you now have all the tools you need to boost your confidence and to put your athlete on the road to recovery. That sinking feeling you had every time the words ‘sore shoulder’ were mentioned has now been banished forever and ‘oh, oh’ has been replaced by a triumphant ‘aha’ – you are now a match for anything that an overhead athlete can throw at you!

Babette Pluim, MD, PhD, MPH, is a Sports and Exercise Physician and Deputy Editor of the BJSM. She is Chief Medical Adviser of the Dutch Tennis Federation and Team Physician of the Dutch Davis Cup and Fed Cup teams.

 

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